- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.48 / $87.40 / $315.76
| Facility | | $12.48 | $87.40 | $315.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.48 / $14.01 / $14.01
| Professional | | $9.48 | $14.01 | $14.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.80 / $7.80 / $7.80
| Facility | | $7.80 | $7.80 | $7.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.52 / $13.63 / $22.58
| Professional | | $8.52 | $13.63 | $22.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.00 / $56.13 / $147.34
| Facility | | $12.00 | $56.13 | $147.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.04 / $7.20 / $18.00
| Professional | | $5.04 | $7.20 | $18.00 |